Practice recommendations for WMR

1.1 Preparation for the rehabilitation

All patients who are likely to receive WMR based on the information already available are to be informed about the objectives of WMR and the related clinic-specific services in the invitation from the rehabilitation facility prior to rehabilitation.

Consent: 100%

1.2 Preparation for the rehabilitation

All patients should be asked in the invitation from the rehabilitation facility to identify the occupational physician and the responsibility for occupational integration management.

Consent: 86.7%

1.3 Preparation for the rehabilitation

The rehabilitation facility is to provide information about its WMR concept on the website.

Consent: 100%

1.4 Preparation for the rehabilitation

In the invitation letter, the rehabilitation facility is to provide information about its online information content about WMR (e.g. via link or QR code).

Consent: 100%

2.1 Assignment

All patients should complete a standardized screening (e.g. SIBAR, SIMBO-C or Würzburger Screening) at the beginning of rehabilitation to identify the need for WMR.

Consent: 94.1%

2.2 Assignment

In the event of a negative screening, assignment to WMR is also to be possible by determining the need in the medical admission interview or in the admission interview with the primary therapist.

Consent: 100%

2.3 Assignment

Before assignment to WMR, contraindications are to be checked by a physician at the rehabilitation facility (e.g. unrealistic prospects of professional reintegration or medical instability).

Consent: 100%

2.4 Assignment

The final decision on assignment to WMR is to be made on the basis of a review of the initial findings, the results of the screening and the clinical intake examinations by the treating persons.

Consent: 100%

2.5 Assignment

If the actual specialist department code determined by the rehabilitation team differs from the assigned specialist department code, i.e. 3197 (WMR) instead of 3100 (psychosomatics) or 3100 (psychosomatics) instead of 3197 (WMR), this should be changed within the first treatment week in the electronic data exchange procedure in accordance with § 301 SGB V (Volume V of the Social Code).

Consent: 92.3%

2.6 Assignment

It is also to be possible to switch to WMR during the rehabilitation in the event of changes to the initial evaluation.

Consent: 100%

2.7 Assignment

More than 75% of the patients actually treated in WMR are to have a positive screening result.

Consent: 100%

2.8 Assignment

The proportion of positive screening results for patients treated in WMR should be evaluated regularly (at least quarterly) and reported back to the team.

Consent: 78.6%

3.1 Goal setting

The return-to-work is to be addressed in the admission interviews and in an information presentation on WMR.

Consent: 100%

3.2 Goal setting

After being referred to WMR, patients are to be informed about WMR and the work-related focus in group or individual discussions.

Consent: 100%

3.3 Goal setting

The motivation of the patients to deal with work-related content is to be clarified in the admission interviews before they are assigned to WMR.

Consent: 100%

3.4 Goal setting

At the beginning of rehabilitation, patients receiving WMR are to develop and formulate specific goals in relation to work-related impairments and difficulties.

Consent: 100%

3.5 Goal setting

The rehabilitation goals are to be developed and agreed in a participatory process and adjusted as necessary during the course of rehabilitation.

Consent: 100%

3.6 Goal setting

The rehabilitation goals are to be reviewed on the basis of the results of the work-related diagnostics and adjusted if necessary.

Consent: 100%

3.7 Goal setting

The rehabilitation goals are to be written down in a goal agreement.

Consent: 100%

3.8 Goal setting

The goal agreement with the work-related goals is to be accessible to the entire rehabilitation team.

Consent: 100%

3.9 Goal setting

All patients are to receive a copy of the goal agreement.

Consent: 100%

4.1 Work-related diagnostics

The work-related diagnostics is to be performed involving various professions at the begin-ning of the rehabilitation program and last at least 90 minutes.

Consent: 100%

4.2 Work-related diagnostics

Another work-related diagnostic should be performed at the end of rehabilitation if additional information is required for the socio-medical assessment of work capacity.

Consent: 84.6%

4.3 Work-related diagnostics

In work-related diagnostics, the mental and physical abilities of the patients receiving WMR are to be assessed againgst the background of their work-related demands (e.g. with the Mini-ICF-APP).

Consent: 100%

4.4 Work-related diagnostics

For employed patients receiving WMR, written and verbal consent to contact the employer and the occupational physicians can be requested at the start of rehabilitation.

Consent: 64.3%

4.5 Work-related diagnostics

A structured description of the work activities should be created on the basis of workplace descriptions from the company, exchanges with occupational physicians or interviews with patients.

Consent: 93.3%

4.6 Work-related diagnostics

A profile of capacities is to be developed on the basis of structured discussions, assessments, clinical examinations and behavioral observations.

Consent: 100%

4.7 Work-related diagnostics

A standardized profile comparison instrument (e.g. Mini-ICF-APP, IMBA or MELBA) is to be used for comparing individual capacities and job demands, and the comparison is to be visualized if necessary.

Consent: 100%

4.8 Work-related diagnostics

The profiles of capacities and demands are to be developed interprofessionally (social work, physiotherapy, ergotherapy, psychology and medicine).

Consent: 100%

4.9 Work-related diagnostics

The profiles of capacities and demands are to be documented for the treatment team to view (e.g. electronic file).

Consent: 100%

4.10 Work-related diagnostics

An interprofessional team conference is to compile the findings of the standardized comparison of demands and capacities, identify over- and underload and plan the individual therapeutic services that are aligned with the job demands.

Consent: 100%

5.1 Psychosocial counseling

Psychosocial counseling is to be provided individually as well as in small groups or groups for a total of at least 90 minutes.

Consent: 100%

5.2 Psychosocial counseling

All WMR patients are to receive at least 60 minutes of individual psychosocial counseling (in several appointments if necessary).

Consent: 100%

5.3 Psychosocial counseling

An initial individual psychosocial counseling session is to be provided within the first two weeks.

Consent: 100%

5.4 Psychosocial counseling

Patients are to receive individual advice on career development prospects during WMR.

Consent: 100%

5.5 Psychosocial counseling

Patients are to receive advice on conflicts in the workplace during WMR.

Consent: 100%

5.6 Psychosocial counseling

Patients are to be advised in WMR on the subject of severe disability under German law and disability rights.

Consent: 100%

5.7 Psychosocial counseling

Patients are to receive advice on vocational rehabilitation during WMR.

Consent: 100%

5.8 Psychosocial counseling

Patients are to be advised on graded return-to-work during WMR.

Consent: 100%

5.9 Psychosocial counseling

Patients should be advised on aftercare (e.g. Psy-RENA) during WMR.

Consent: 94.1%

5.10 Psychosocial counseling

Patients should be advised during WMR on how to consolidate the results of their rehabilitation.

Consent: 94.1%

5.11 Psychosocial counseling

Patients who do not have a job or for whom it is foreseeable that they will not be able to return to their old job should be offered support with job applications.

Consent: 93.3%

5.12 Psychosocial counseling

Patients are to be prepared for meetings with the employer or staff representatives.

Consent: 100%

5.13 Psychosocial counseling

With their consent, patients are to be supported in contacting their employer or staff representatives during their rehabilitation.

Consent: 100%

6.1 Work-related groups

Work-related groups are to last at least 240 minutes.

Consent: 100%

6.2 Work-related groups

In the work-related groups, the challenges of workplace training are to be reflected on with the patients.

Consent: 100%

6.3 Work-related groups

In the work-related groups, stress and time management strategies for the workplace are to be developed with the patients.

Consent: 100%

6.4 Work-related groups

In the work-related groups, individual disease models are to be developed in which the interactions between mental illness and the job situation are revealed.

Consent: 100%

6.5 Work-related groups

In the work-related groups, concrete action plans for returing to work are to be developed as early as possible (e.g.: Who is addressed and when? When will the patient return to work? Who can provide support? Who or what is a barrier?)

Consent: 100%

6.6 Work-related groups

Job anxiety is to be addressed in the work-related groups.

Consent: 100%

6.7 Work-related groups

In the work-related groups, workplace-related coping strategies are to be developed together with the patients.

Consent: 100%

6.8 Work-related groups

In the work-related groups, the social skills of the patients are to be strengthened through practical exercises (e.g. role plays).

Consent: 100%

6.9 Work-related groups

The work-related groups are to use psychoeducational content to clarify the connections between the patients’ individual symptoms and work-related stress.

Consent: 100%

6.10 Work-related groups

Workplace-related conflict resolution is to be strengthened and tested through exercises in the work-related groups.

Consent: 100%

6.11 Work-related groups

Work-related self-efficacy is to be strengthened through exercises in the work-related groups.

Consent: 100%

7.1 Workplace training

If workplace training is provided, it should last at least 360 minutes.

Consent: 81.8%

7.2 Workplace training

At the beginning of the workplace training, an individual profile of work ability related to the job demands of the patients is to be created.

Consent: 100%

7.3 Workplace training

At the beginning of the workplace training, verifiable sub-goals are to be jointly defined, con-sidering the work-related goals.

Consent: 100%

7.4 Workplace training

In workplace training, the aim is to try out work situations that are relevant to coping with work.

Consent: 100%

7.5 Workplace training

The stress management strategies developed in the work-related groups should be tested as part of the workplace training.

Consent: 94.1%

7.6 Workplace training

Workplace training should train how to deal with work-related stress.

Consent: 94.1%

7.7 Workplace training

All patients who receive workplace training are to develop individual strategies to transfer what they have learned into everyday life and the workplace.

Consent: 100 %

7.8 Workplace training

Transfer strategies for implementing what has been learned into everyday post-rehabilitation life should be written down with the patients.

Consent: 93.3%

7.9 Workplace training

In the case of somatic comorbidity, relevant movement sequences and posture patterns are also to be trained in a psychosomatic setting.

Consent: 100%

7.10 Workplace training

Cognitive skills are to be practiced in workplace training.

Consent: 100%

7.11 Workplace training

Interactional difficulties are to be made perceptible in workplace training through group tasks and worked on together.

Consent: 100%

8.1 Return-to-work management

An extension of the rehabilitation stay is to be discussed with the patients as early as possible.

Consent: 100%

8.2 Return-to-work management

In the case of persons who were on sick leave for more than six weeks in the last twelve months, the use of occupational integration management is to be examined and prepared if necessary.

Consent: 100%

8.3 Return-to-work management

If there is interest in occupational integration managment, the person is to be supported in contacting the employer.

Consent: 100%

8.4 Return-to-work management

The initation of graded return-to-work is to be examined for persons who were on sick leave for at least three months in the twelve months prior to rehabilitation.

Consent: 100%

8.5 Return-to-work management

The preparation of graded return-to-work is to include individual counseling of the person regarding the content and course of the measure as well as the financial consequences of taking advantage of it, coordination of the start, duration, gradual plan and accompanying measures (e.g. adaptation of work tasks) with the person and the employer and a definition of these features as well as documentation.

Consent: 100%

8.6 Return-to-work management

If the patient’s ability to perform her or his last job is limited, vocational rehabilitation is to be explained in a personal meeting and recommended in the discharge report.

Consent: 100%

8.7 Return-to-work management

If vocational rehabilitation is recommended in the discharge report, vocational rehabilitation is to be requested for together during WMR.

Consent: 100%

8.8 Return-to-work management

In the event of unemployment or impending unemployment, individual career options are to be discussed.

Consent: 100%

8.9 Return-to-work management

In the event of unemployment or impending unemployment, the person is to be supported in finding the adress of the responsible employment agency or job center.

Consent: 100%

8.10 Return-to-work management

In the event of unemployment or impending unemployment, the person is to be supported during rehabilitation in contacting the relevant employment agency or job center by telephone.

Consent: 100%

8.11 Return-to-work management

People who are likely to have limited ability to work in the general labor market are to be given detailed advice on the various types of pensions and informed about the local information and German Pension Insurance information and advice centers, local voluntary insurance advisors of the German Pension Insurance as well as the website and service telephone of the responsible pension insurance provider.

Consent: 100%

8.12 Return-to-work management

The discharge report is to include a detailed socio-medical appraisal for persons with limited ability to work.

Consent: 100%

8.13 Return-to-work management

A plan for returning to work should be developed together with the patients and documented in a suitable manner.

Consent: 93.8%

8.14 Return-to-work management

The return-to-work plan is to specify the concrete integration goal, the necessary steps following WMR and the stakeholders to be involved.

Consent: 100%

8.15 Return-to-work management

At the end of WMR, the rehabilitation facility is to check whether further support from integrational service should be initiated.

Consent: 100%

8.16 Return-to-work management

The rehabilitation facility is to check at an early stage during WMR whether case management should be initiated, advise patients on how to make use of it and initiate case management – if available through the pension insurance provider.

Consent: 100%

8.17 Return-to-work management

Patients should receive two separate copies of the release report, which can be passed on to other persons providing treatment (e.g. occupational physicians, but also psychotherapists) so that they are informed about the goals and results of WMR, but especially about the aftercare recommendations.

Consent: 85.7%

8.18 Return-to-work management

Within the scope of its financial and personnel resources, the rehabilitation facility can support the patients in transferring what they have learned over three months through regular contact (e.g. by telephone or digitally).

Consent: 61.5%

9.1 Team

The facility is to have a concept for the provision of WMR that can be viewed by the entire rehabilitation team.

Consent: 100%

9.2 Team

Every rehabilitation facility should have a steering group that is responsible for the implementation and further development of WMR.

Consent: 93.3%

9.3 Team

The clinic management should inform all employees about the tasks, rights and duties of the steering group.

Consent: 80%

9.4 Team

All persons involved in WMR are to be familiar with the guideline for conducting WMR, the facility’s concept of WMR and the extended practice recommendations for conducting WMR in psychosomatic rehabilitation facilities.

Consent: 100%

9.5 Team

All persons providing treatment involved in rehabilitation are to be trained to recognize need for WMR during the admission interview.

Consent: 100%

9.6 Team

In job advertisements for professionals who are to be assigned to WMR as persons providing treatment, the job requirements should be precisely formulated.

Consent: 85.7%

9.7 Team

New employees are to receive training on the patients treated and assignment as well as the content and scope of WMR as part of their onboarding.

Consent: 100%

9.8 Team

Rehabilitation facilities are to have a process in place if a therapist changes during rehabilitation.

Consent: 100%

9.9 Team

All persons providing treatment involved in WMR are to be given the opportunity to take part in WMR training.

Consent: 100%

9.10 Team

The persons providing WMR treatment should receive regular training to improve processes relevant to rehabilitation (e.g. stress management, team communication or communication with patients).

Consent: 93.3%

9.11 Team

As far as the financial and personnel resources of the rehabilitation facility allow, persons providing treatment should be given the opportunity to gain practical insights into common work fields of the patients (e.g. factory visits or job shadowing).

Consent: 84.6%

9.12 Team

An interprofessional case conference is to be held at least once a week as part of the treatment team carrying out the WMR.

Consent: 100%

9.13 Team

All WMR practitioners are to receive regular supervision and intervision in order to be able to discuss complex cases.

Consent: 100%

9.14 Team

The individual course of treatment during WMR is to be documented jointly by the rehabilitation team (e.g. electronic patient file).

Consent: 100%

10.1 Cooperation with external institutions

Rehabilitation facilities should provide information points with internet access where patients can obtain information on issues relating to professional and working life and search for jobs online (e.g. the Federal Employment Agency´s career information center).

Consent: 93.3%

10.2 Cooperation with external institutions

The information points should be presented to unemployed people and people at risk of unemployment.

Consent: 83.3%

10.3 Cooperation with external institutions

Rehabilitation facilities should recommend that unemployed patients and patients at risk of unemployment visit the Federal Emplyment Agency´s career information center after completing rehabilitation at their home location.

Consent: 76.9%

10.4 Cooperation with external institutions

The rehabilitation facility is to inform patients about the relevance of cooperation with external stakeholders such as employers or the company medical service.

Consent: 100%

10.5 Cooperation with external institutions

If consent is given, the rehabilitation facility is to contact the employer (human resources department or superiors) in order to clarify conflicts, suggest continued employment in line with the insured person´s condition if their performance is limited and, if necessary, initiate a graded return-to-work into the existing workplace.

Consent: 100%

10.6 Cooperation with external institutions

When planning graded return-to-work, the rehabilitation facility is to involve the occupational physician with the consent of the patients.

Consent: 100%

10.7 Cooperation with external institutions

Rehabilitation facilities should maintain contact with regional employers in order to stay informed about the complexities of the current labor market, employer requirements and how to deal with work-related problems.

Consent: 83.3%

10.8 Cooperation with external institutions

Rehabilitation facilities are to develop and maintain cooperation with other external stakeholders (e.g. integrational service, vocational training centers and regional social and outpatient services).

Consent: 100%